CTSIB Reboot

As a therapist that was not doing so well in serving my balance/vestibular clients, I’ve done several continuing education courses on the topic to fill in the gaps I could see in my skill set. During the courses I took this past fall, the instructors were intent on utilizing the Clinical Test of Sensory Integration and Balance (CTSIB) on balance patients to divine which of the three parts of balance was contributing most to balance deficits– somatosensory, vestibular or visual– or as “a poor therapist’s computerized dynamic posturography.” In order to use this test for this purpose, they emphasized that as a profession we need to move back to the original test, and cease using the modified version, also known as mCTSIB. Basically, no one has the “visual conflict dome” so we as a whole just threw that part out. The intructors conclusions made sense to me, but that posed a problem: how to get my hands on a dome.

So of course I went to my friends eBay and Google. First on eBay there were no ready made domes for sale. Boo. I really didn’t want to make one. So I went to Google to find instructions for making one. The only somewhat useful item I found was this article. Everything else I saw (including personally asking the course instructors) was referencing it for instructions on the second page there. And those instructions… HA! Those are NOT instructions on making anything. They’re pretty good generalizations with some pictures of what it’s supposed to look like and what it’s made of.

So what’s an aspiring balance therapist to do?! Innovate! That article was helpful in that it told me the purpose of the dome: “Once fitted, the dome provides a ‘sway referenced’ visual input, wherein the visual stimulus moves in phase with the head of the patient. It is essential to block out all surrounding visual stimuli, in order to be able to truly test the response of the individual when the vision is sway referenced.” So I set out to create my own and here I am modeling what I came up with.

Materials:

— plastic chemical/impact goggles ($3 from Home Depot)

— white tissue paper ($1 Target)

— home-made Mod Podge (70 cents Target) click the link for the instructions to make the Mod-Podge

— small paint brush (I had this, but you can get any smaller paint brush as your local craft store like Hobby Lobby for $1-2)

— sway reference (I used colored duct tape, but you can use a small sticker or just draw a line on with a Sharpie… whatever you have around the house.)

Instructions: Decoupage on 2 layers (about half a sheet) of white tissue paper. Allow to dry fully (overnight best) between layers. Then add two vertical strips of colored duct tape on the inside of the goggles to provide the sway reference.

Then since the decoupage is a bit delicate to be throwing in and rolling around in my bag of therapy goodies, I repurposed a take-out container as a case for the goggles.

So there you have it. That’s been the project I worked on last week when I wasn’t with my family. Decoupaging is rather relaxing, although it is slightly time consuming. It probably took me about an hour to put on each layer x 2 layers = about 2 hours total. Although this could be a patient activity! I think it’s ready for use now. I even have a patient in mind to try it out on. What do ya’ll think? Do you think my “visual conflict goggles” will serve a similar purpose as the dome? The only draw back I can see is that you have to make sure the goggles are on snuggly, so no other visual cues get in around the edges. And there’s a bit of a hair mess-up factor, but the dome I wore in PT school did that too.

Feel free to message me with questions if you’d like to try to make some and my instructions aren’t clear enough.